title: Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis.
abstract: BACKGROUND
  To examine the safety and efficacy of topical use of tranexamic acid (TA) in total knee arthroplasty (TKA).
  
  
  METHODS
  An electronic literature search of PubMed Medline; Ovid Medline; Embase; and the Cochrane Library was performed, identifying studies published in any language from 1966 to February 2013. The studies enrolled adults undergoing a primary TKA, where topical TA was used. Inverse variance statistical method and either a fixed or random effect model, depending on the absence or presence of statistical heterogeneity were used; subgroup analysis was performed when possible.
  
  
  RESULTS
  We identified a total of seven eligible reports for analysis. Our meta-analysis indicated that when compared with the control group, topical application of TA limited significantly postoperative drain output (mean difference: -268.36ml), total blood loss (mean difference=-220.08ml), Hb drop (mean difference=-0.94g/dL) and lowered the risk of transfusion requirements (risk ratio=0.47, 95CI=0.26-0.84), without increased risk of thromboembolic events. Sub-group analysis indicated that a higher dose of topical TA (>2g) significantly reduced transfusion requirements.
  
  
  CONCLUSIONS
  Although the present meta-analysis proved a statistically significant reduction of postoperative blood loss and transfusion requirements with topical use of TA in TKA, the clinical importance of the respective estimates of effect size should be interpreted with caution.
  
  
  METHODS
  I, II.
authors.affiliation: Leeds Teaching Hospitals, University of Leeds, United Kingdom.
authors.forename: Michalis
authors.initials: M
authors.lastname: Panteli
authors.forename: Costas
authors.initials: C
authors.lastname: Papakostidis
authors.forename: Ziad
authors.initials: Z
authors.lastname: Dahabreh
authors.forename: Peter V
authors.initials: PV
authors.lastname: Giannoudis
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007270:Injections, Intra-Articular; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D019106:Postoperative Hemorrhage / Q000188:drug therapy* / Q000517:prevention & control; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D014148:Tranexamic Acid / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid
keywords: Antifibrinolytics; Cyklokapron; Intra-articular; Topical tranexamic acid; Total knee arthroplasty